Laser in situ keratomileusis to manage refractive errors after deep anterior lamellar keratoplasty

• Published in: Journal of cataract and refractive surgery Vol. 38; no. 6; pp. 1020 - 1027
• Main Authors: Acar, Banu Torun, MD, Utine, Canan A., MD, MSc, Acar, Suphi, MD, Ciftci, Ferda, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2012; Elsevier
• Subjects: Adult; Astigmatism - etiology; Astigmatism - physiopathology; Astigmatism - surgery; Biological and medical sciences; Cohort Studies; Corneal Topography; Corneal Transplantation; Female; Humans; Keratoconus - surgery; Keratomileusis, Laser In Situ; Lasers, Excimer - therapeutic use; Male; Medical sciences; Middle Aged; Myopia - etiology; Myopia - physiopathology; Myopia - surgery; Ophthalmology; Postoperative Complications; Refraction, Ocular - physiology; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Vision disorders; Visual Acuity - physiology; Young Adult; Eye disease; Keratomileusis; Treatment; Vision disorder; Surgery; In situ; Laser; Refractive error; Anterior; Lamellar graft; Ophthalmology
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2011.12.034

Purpose To analyze the visual and refractive outcomes of laser in situ keratomileusis (LASIK) after deep anterior lamellar keratoplasty (DALK) for keratoconus. Setting Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey. Design Cohort study. Methods Patients with compound myopic astigmatism after DALK and a spherical equivalent (SE) between −2.50 diopters (D) and −8.00 D had LASIK as a single-step procedure, correcting the manifest refraction error. The visual and refractive results at 1 month, 3 months, and the last follow-up were compared with preoperative values. Results The mean follow-up was 11.17 months ± 3.61 (SD). The mean manifest refraction SE (MRSE) and autorefractometer measurements and the autokeratorefractometer and corneal topography keratometry readings decreased significantly from preoperatively to 1 month postoperatively ( P <.01) but did not change significantly thereafter ( P >.05). Preoperatively, the mean uncorrected (UDVA) and corrected (CDVA) distance visual acuities were 0.21 ± 0.08 and 0.73 ± 0.08, respectively; postoperatively, the means were 0.73 ± 0.10 and 0.98 ± 0.05, respectively. All eyes achieved a postoperative UDVA better than 0.5. No eye lost CDVA lines. The safety index was 1.34. The mean MRSE was −5.18 ± 1.74 D preoperatively and −1.05 ± 0.64 D postoperatively ( P <.01). Postoperatively, 11 eyes (91.67%) were within ±2.00 D of the SE, 8 (6.67%) were within ±1.00 D, and 5 (41.67%) were within ±0.50 D. No complications were encountered. Conclusion Treatment of post-DALK keratoconus patients with LASIK to correct manifest refraction error seems to be a viable option. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.